Skilled Nursing Facilities Workforce Standards Program
Assembly Bill (AB) 186 (Chapter 46, Statutes of 2022) authorized the Workforce Standards Program (WSP) for Freestanding Skilled Nursing Facilities (SNF) Level-B and Adult Freestanding Subacute Facilities Level-B effective for calendar year (CY) 2024. The WSP will provide an enhanced Medi-Cal per diem rate, including a workforce rate adjustment, to facilities that maintain a Collective Bargaining Agreement (CBA), participate in a statewide multi-employer labor management committee (LMC), or meet basic wages and benefit standards established by DHCS. The detailed requirements and rules of the WSP are described in Supplement 6 of Attachment 4.19-D of the California Medicaid State Plan 24-0004.
CY 2024 and CY 2025 Opt-In Process
The WSP for CY 2024 and/or CY 2025 Opt-in process is closed, and program implementation is under way.
WSP Rate Adjustment
DHCS has published the CY 2024 rate studies on the Freestanding Skilled Nursing Facilities and Subacute Units website. The CY 2024 rate studies calculate both the enhanced and basic per diem rates for each facility showing the rate with and without the Workforce Rate Adjustment. The publication of the CY 2024 rate studies does not update the current rates on file. Facilities will continue to receive the CY 2023 rates on file until CY 2024 rates on file are published pending the Workforce Standards Opt-in Process and final federal approval of SPA 24-0004.
DHCS will process WSP opt-in forms on a batch basis and, upon acceptance into the WSP, will publish the facility's updated CY 2024 and CY 2025 rates on file reflecting the facility's opt-in decision. Facilities that have not opted-into the WSP by December 9, 2024, will default to the basic per diem rate for CY 2024 and CY 2025, without the workforce rate adjustment. Managed Care Plans will be notified of updated rates on file as they are published.
Collective Bargaining Agreement (CBA) Pathway
Facilities participating through the CBA Pathway must submit a completed Schedule 3: Collective Bargaining Agreement and upload signed copies of the terms of agreement and signature pages of all collective bargaining agreements that cover the direct labor workers at their facility on the Workforce Standards Program Opt-In Form. At least a majority of the facility’s applicable direct care workers must be covered by a collective bargaining agreement compliant with the requirements of Section 2.1(a)(ii) of Supplement 6 of Attachment 4.19-D of the California Medicaid State Plan. Facilities must also notify DHCS of any revised, extended, or new collective bargaining agreements that cover applicable workers within 30 days of such agreement taking effect.
If a facility does not currently have a signed CBA but is in the process of extending or negotiating a new CBA, the facility cannot opt into the WSP via the CBA Pathway. However, the facility may opt into the WSP via the Basic Wage and Benefit Pathway and switch to the CBA Pathway when it is eligible as described below. A CBA that is entered into after the beginning of a rate year and includes terms making it retroactively effective to the beginning of the rate year, may be considered effective for the entire duration of the rate year for the purposes of the CBA Pathway.
Labor Management Committee (LMC) Pathway
Facilities participating through the LMC Pathway do not need to submit any additional documents at the time of opt-in. However, the facility must specify a certified LMC on its opt-in form and must ensure that the certified LMC lists the facility as a member on its LMC Certification Form. Please see this page for additional information on the LMC Certification website.
Basic Wage and Benefit (BWB) Pathway
Facilities participating through the Basic Wage and Benefit Pathway must include a completed Schedule 2: Health Benefit Plan Benchmark Plan on the Workforce Standards Program Opt-In Form.
Facilities in the Basic Wage and Benefit Pathway must submit the Basic Wage and Benefit Opt-In Compliance Attestation Form within 105 days of the applicable date. For CY 2024 and CY 2025 the applicable date is the day that DHCS publishes the facility’s CY 2024 and CY 2025 rate on file on the Freestanding Skilled Nursing Facilities and Subacute Units website reflecting the facility’s opt-in decision. DHCS will note the applicable date for CY 2024 and CY 2025 in the rate file published online.
The Compliance Attestation Form is required to certify that, in accordance with program requirements, the facility began paying and providing basic wages and benefits prospectively within 30 days of the applicable date and provided payment and credit of the basic wages and benefits retroactive to the first day of the rate year within 90 days of the applicable date. For facilities that received approval of the CY 2024 and or CY 2025 BWB Pathway, the applicable dates and their respective compliance deadlines are listed in the table below. Please check your facility’s acceptance letter to find out your facility’s applicable date.
Compliance Deadline Tables
| Prospective Compliance Date | No later than 3/29/2025 |
| Retroactive Compliance Date | No later than 5/28/2025 |
| Attestation Due Date | No later than 6/12/2025
|
| Prospective Compliance Date | No later than 4/13/2025 |
| Retroactive Compliance Date | No later than 6/12/2025 |
| Attestation Due Date | No later than 6/27/2025
|
| Prospective Compliance Date | No later than 5/11/2025 |
| Retroactive Compliance Date | No later than 7/10/2025 |
| Attestation Due Date | No later than 7/25/2025
|
Facilities may submit a Basic Wage and Benefit Compliance Extension Request Form to request an extension for either of these deadlines for good cause. Extensions may be requested in 30-day increments. DHCS expects facilities to submit an Extension Request Form before the expiration of any required deadline or previously requested extended deadline. Facilities must provide clear and convincing evidence of good cause, such as documentation of communications with Managed Care Plans. The approval of extension requests is in DHCS's sole direction. Facilities that receive an approved extension for either compliance deadline are required to submit the Basic Wage and Benefit Opt-In Compliance Attestation Form no later than 15 days after the extended deadline.
Facilities that fail to submit the Compliance Attestation Form or a Compliance Extension Request Form by the required deadlines may be removed from the Workforce Standards Program and default to the basic per diem rate without the workforce rate adjustment.
DHCS is providing an additional WSP Health Benefits Standards Guidance tool to aid facilities in determination of compliance under the BWB pathway. This guidance is intended to assist facilities in complying with the Health Benefit Standard as outlined in Supplement 6 to Attachment 4.19-D of the California State Plan. The following examples and worksheet are intended to help employers determine their Benchmark Plan, the Required Employer Contribution to Premium of the plan the employee selects, Maximum Employee Contribution to Premium of their selected plan, and the Required Excess Stipend that must be provided as a stipend or deposited in a health benefit account by the employer based on the employee’s plan. DHCS is not requiring facilities to submit this worksheet to DHCS. It is a tool to help facilities determine their obligations to meet the Health Benefit Standard under the BWB pathway. For audit purposes, facilities should maintain appropriate documentation of compliance with the Health Benefit Standard. While the tool is an optional aid, DHCS will require facilities to attest to reviewing the tool when completing the 105 day attestation form.
Switching Pathways
Facilities may switch pathways during the opt-in period for each future rate year. During a rate year, facilities may switch pathways only in specified circumstances.
If a facility opted into the Workforce Standards Program via the CBA or LMC Pathway but ceases to meet the pathway’s requirements during the rate year, the facility must notify the department within 30 days of ceasing to meet the pathway’s requirements. The facility shall have a special opt-in period lasting 30 days from the date the facility ceased to qualify via the original pathway during which the facility may opt to continue in the Workforce Standards Program via another qualifying pathway by notifying DHCS.
If a facility opted into the Workforce Standards Program via the Basic Wages and Benefits Pathway but during the rate year becomes eligible through the CBA or LMC pathway, the facility may switch pathways by notifying DHCS within 30 days.
Additional Forms & Notifications
DHCS is continuing to develop additional forms and notification templates. Until such time these forms are published, facilities should submit any required requests or notifications in writing to SNFWSP@dhcs.ca.gov. For each item, the parenthetical notes the applicable sections of Supplement 6 of Attachment 4.19-D of the California Medicaid State Plan.
- Mid-Year Switch of Pathway (section 3 (e) and (f))
- Mid-Year CBA Update (Section 5(b))
- Mid-Year Health Benefit Update (Section 6.2(d))
- Program Opt-Out (Section 3(g))
- Non-Willful Non-Compliance Waiver Request (Section 7(c))
Basic Wage Standard
Helpful Links
Nursing Facility Financing Reform (AB 186) website
Freestanding Skilled Nursing Facilities and Subacute Units website
AB 186 Workforce Standards FS/SNF and FS/SA Policy Letter 24-001
LTC Rates Policy Letter 24-003: WSP Deadline Extension
Approved State Plan Amendment 24-0004
AB 186 Email List Subscriber
Medi-Cal Subscription Services (MCSS)
Contact Us
For any questions about the opt-in process or opt-in forms, please send an email to SNFWSP@dhcs.ca.gov.
